Lever actuated output gimbals

ABSTRACT

A force transmission transmits a force to a primary output gimbal plate and a secondary output gimbal plate. The secondary output gimbal plate supports the primary output gimbal plate. Each of three primary levers is supported by a primary pivot. Each primary lever is coupled to the primary output gimbal plate such that the three couplings are not collinear. Each of three secondary levers is supported by a secondary pivot. Each secondary lever is coupled to one of the primary levers by a force applying connector. Each secondary lever is coupled to the secondary output gimbal plate such that the three couplings are not collinear. The output gimbal plates may be coupled to the levers by flexible cables. The cables may be substantially contained within a tube. The output gimbal plates may be substantially smaller than the input gimbal plate.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of application Ser. No. 12/780,758,filed May 14, 2010, which is hereby incorporated by reference in itsentirety.

BACKGROUND

Field

Embodiments of the invention relate to the field of force transmissions;and more specifically, to force transmissions for use in surgicalinstruments intended for use in minimally invasive surgeries.

Background

Minimally invasive surgery (MIS) (e.g., endoscopy, laparoscopy,thoracoscopy, cystoscopy, and the like) allows a patient to be operatedupon through small incisions by using elongated surgical instrumentsintroduced to an internal surgical site. Generally, a cannula isinserted through the incision to provide an access port for the surgicalinstruments. The surgical site often comprises a body cavity, such asthe patient's abdomen. The body cavity may optionally be distended usinga clear fluid such as an insufflation gas. In traditional minimallyinvasive surgery, the surgeon manipulates the tissues by usinghand-actuated end effectors of the elongated surgical instruments whileviewing the surgical site on a video monitor.

The elongated surgical instruments will generally have an end effectorin the form of a surgical tool such as a forceps, a scissors, a clamp, aneedle grasper, or the like at one end of an elongate tube. The surgicaltool is generally coupled to the elongate tube by one or morearticulated sections to control the position and/or orientation of thesurgical tool. An actuator that provides the actuating forces to controlthe articulated section is coupled to the other end of the elongatetube. A means of coupling the actuator forces to the articulated sectionruns through the elongate tube. Two actuators may be provided to controltwo articulated sections, such as an “arm” that positions the surgicaltool and a “wrist” the orients and manipulates the surgical tool, withmeans for coupling both actuator forces running through the elongatetube.

It may desirable that the elongate tube be somewhat flexible to allowthe surgical instrument to adapt to the geometry of the surgical accesspath. In some cases, the articulated sections provide access to asurgical site that is not directly in line with the surgical accessport. It may be desirable to use cables as the means of coupling theactuator forces to the articulated sections because of the flexibilitythey provide and because of the ability of a cable to transmit asignificant force, a substantial distance, through a smallcross-section. However, a cable is generally only able to transmit aforce in tension. Thus it is generally necessary to provide two cablesto transmit a bidirectional actuating force. This doubles thecross-section required for the cables to pass through the elongate tube.

In view of the above, it is desirable to provide an improved apparatusand method for transmitting bidirectional actuating forces through anelongate tube of a surgical instrument intended for use in minimallyinvasive surgeries that reduces the cross-section required in theelongate tube.

SUMMARY

A force transmission transmits a force to a primary output gimbal plateand a secondary output gimbal plate. The secondary output gimbal platesupports the primary output gimbal plate. Each of three primary leversis supported by a primary pivot. Each primary lever is coupled to theprimary output gimbal plate such that the three couplings are notcollinear. Each of three secondary levers is supported by a secondarypivot. Each secondary lever is coupled to one of the primary levers by aforce applying connector. Each secondary lever is coupled to thesecondary output gimbal plate such that the three couplings are notcollinear. The output gimbal plates may be coupled to the levers byflexible cables. The cables may be substantially contained within atube. The output gimbal plates may be substantially smaller than theinput gimbal plate. Other features and advantages of the presentinvention will be apparent from the accompanying drawings and from thedetailed description that follows below.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may best be understood by referring to the followingdescription and accompanying drawings that are used to illustrateembodiments of the invention by way of example and not limitation. Inthe drawings, in which like reference numerals indicate similarelements:

FIG. 1 is a simplified perspective view of a teleoperated surgicalsystem with a remotely controlled surgical instrument inserted through aport in a patient's abdomen.

FIG. 2 is a plan view of a surgical instrument for use with ateleoperated manipulator.

FIG. 3 is a perspective view of the surgical instrument shown in FIG. 2.

FIG. 4 is a perspective view of a coupler portion of a teleoperatedmanipulator used with the surgical instrument shown in FIG. 2.

FIG. 5 is a simplified perspective view of a force transmissionmechanism.

FIG. 6 is a bottom view of a portion of the force transmission mechanismshown in FIG. 5.

FIG. 7 is a top view of a portion of the force transmission mechanismshown in FIG. 5.

FIG. 8 is a side view of a portion of the force transmission mechanismshown in FIG. 5.

FIG. 9 is a simplified perspective view of another force transmissionmechanism.

FIG. 10A is a portion of the force transmission mechanism shown in FIG.9 in a first position.

FIG. 10B is a portion of the force transmission mechanism shown in FIG.9 in a second position.

FIG. 11 is a front view of a portion of still another force transmissionmechanism.

FIG. 12 is an oblique view of the force transmission mechanism of FIG.11.

FIG. 13 is a plan view of an input gimbal.

FIG. 14 is a schematic representation of the force transmissionmechanism of FIG. 11.

DETAILED DESCRIPTION

In the following description, numerous specific details are set forth.

However, it is understood that embodiments of the invention may bepracticed without these specific details. In other instances, well-knowncircuits, structures and techniques have not been shown in detail inorder not to obscure the understanding of this description.

In the following description, reference is made to the accompanyingdrawings, which illustrate several embodiments of the present invention.It is understood that other embodiments may be utilized, and mechanicalcompositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of the presentdisclosure. The following detailed description is not to be taken in alimiting sense, and the scope of the embodiments of the presentinvention is defined only by the claims of the issued patent.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.Spatially relative terms, such as “beneath”, “below”, “lower”, “above”,“upper”, and the like may be used herein for ease of description todescribe one element's or feature's relationship to another element(s)or feature(s) as illustrated in the figures. It will be understood thatthe spatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if the device in thefigures is turned over, elements described as “below” or “beneath” otherelements or features would then be oriented “above” the other elementsor features. Thus, the exemplary term “below” can encompass both anorientation of above and below. The device may be otherwise oriented(e.g., rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly.

As used herein, the singular forms “a”, “an”, and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising” specify the presence of stated features, steps,operations, elements, and/or components, but do not preclude thepresence or addition of one or more other features, steps, operations,elements, components, and/or groups thereof.

FIG. 1 is a simplified diagrammatic perspective view of a teleoperatedsurgical system 100, in accordance with embodiments of the presentinvention. The system 100 includes a support assembly 110 mounted to ornear an operating table supporting a patient's body 122. The supportassembly 110 supports one or more surgical instruments 120 that operateon a surgical site within the patient's body 122.

The term “instrument” is used herein to describe a device configured tobe inserted into a patient's body and used to carry out surgicalprocedures. The instrument includes a surgical tool, such as a forceps,a needle driver, a shears, a bipolar cauterizer, a tissue stabilizer orretractor, a clip applier, an anastomosis device, an imaging device(e.g., an endoscope or ultrasound probe), and the like. Some instrumentsused with embodiments of the invention further provide an articulatedsupport for the surgical tool so that the position and orientation ofthe surgical tool can be manipulated.

The simplified perspective view of the system 100 shows only a singleinstrument 120 to allow aspects of the invention to be more clearlyseen. A functional teleoperated surgical system would further include avision system that enables the operator to view the surgical site fromoutside the patient's body 122. The vision system can include a videomonitor for displaying images received by an optical device provided ata distal end of one of the surgical instruments 120. The optical devicecan include a lens coupled to an optical fiber which carries thedetected images to an imaging sensor (e.g., a CCD or CMOS sensor)outside of the patient's body 122. Alternatively, the imaging sensor maybe provided at the distal end of the surgical instrument 120, and thesignals produced by the sensor are transmitted along a lead orwirelessly for display on the monitor. An illustrative monitor is thestereoscopic display on the surgeon's cart in the da Vinci® SurgicalSystem, marketed by Intuitive Surgical, Inc., of Sunnyvale Calif.

A functional teleoperated surgical system would further include acontrol system for controlling the insertion and articulation of thesurgical instruments 120. This control may be effectuated in a varietyof ways, depending on the degree of control desired, the size of thesurgical assembly, and other factors. In some embodiments, the controlsystem includes one or more manually operated input devices, such as ajoystick, exoskeletal glove, or the like. These input devices controlservo motors which, in turn, control the articulation of the surgicalassembly. The forces generated by the servo motors are transferred viadrivetrain mechanisms, which transmit the forces from the servo motorsgenerated outside the patient's body 122 through an intermediate portionof the elongate surgical instrument 120 to a portion of the surgicalinstrument inside the patient's body 122 distal from the servo motor.Persons familiar with telemanipulative, teleoperative, and telepresencesurgery will know of systems such as the da Vinci® Surgical System andthe Zeus® system originally manufactured by Computer Motion, Inc. andvarious illustrative components of such systems.

The surgical instrument 120 is shown inserted through an entry guide124, e.g., a cannula in the patient's abdomen. A functional teleoperatedsurgical system may provide an entry guide manipulator (not shown; inone illustrative aspect the entry guide manipulator is part of thesupport system 110) and an instrument manipulator (discussed below). Theentry guide 124 is mounted onto the entry guide manipulator, whichincludes a positioning system for positioning the distal end of theentry guide 124 at the desired target surgical site. The positioningsystem may be provided in a variety of forms, such as a serial link armhaving multiple degrees of freedom (e.g., six degrees of freedom) or ajointed arm that provides a remote center of motion (due to eitherhardware or software constraints) and which is positioned by one or moreunpowered, lockable setup joints mounted onto a base. Alternatively, theentry guide manipulator may be manually maneuvered so as to position theentry guide 124 in the desired location. In some telesurgicalembodiments, the input devices that control the manipulator(s) may beprovided at a location remote from the patient (outside the room inwhich the patient is placed). The input signals from the input devicesare then transmitted to the control system, which, in turn, manipulatesthe manipulators 130 in response to those signals. The instrumentmanipulator may be coupled to the entry guide manipulator such that theinstrument manipulator 130 moves in conjunction with the entry guide124.

The surgical instrument 120 is detachably connected to the teleoperatedinstrument manipulator 130. The teleoperated manipulator includes acoupler 132 to transfer controller motion from the teleoperatedmanipulator to the surgical instrument 120. The instrument manipulator130 may provide a number of controller motions which the surgicalinstrument 120 may translate into a variety of movements of the endeffector on the surgical instrument such that the input provided by asurgeon through the control system is translated into a correspondingaction by the surgical instrument.

FIG. 2 is a plan view of an illustrative embodiment of the surgicalinstrument 120, comprising a distal portion 250 and a proximal controlmechanism 240 coupled by an elongate tube 210. The distal portion 250 ofthe surgical instrument 120 may provide any of a variety of surgicaldevices such as the forceps 256 shown, a needle driver, a cauterydevice, a cutting tool, an imaging device (e.g., an endoscope orultrasound probe), or a combined device that includes a combination oftwo or more various tools and imaging devices. In the embodiment shown,the surgical tool 256 is coupled to the elongate tube 210 by twoarticulated sections, a “wrist” 252 and a “joggle joint” 254, coupled bya tubular section 258 that allow the position and orientation of thesurgical tool to be manipulated.

Surgical instruments that are used with the invention are controlled bya plurality of flexible cables. Cables provide a means of transmittingforces to the joints that is compact and flexible. A typical elongatetube 210 for a surgical instrument 120 is small, perhaps six millimetersin diameter, roughly the diameter of a large soda straw. The diminutivescale of the mechanisms in the surgical instrument 120 creates uniquemechanical conditions and issues with the construction of thesemechanisms that are unlike those found in similar mechanisms constructedat a larger scale because forces and strengths of materials do not scaleat the same rate as the size of the mechanisms. The cables must fitwithin the elongate tube 210 and be able to bend as they pass throughthe joints 252, 254 that offset the surgical tool 262.

FIG. 3 is a perspective view showing the proximal control mechanism 240of the surgical instrument 120 in more detail. In this embodiment, agimbal assembly 300 is provided to receive a controlling input. Thegimbal assembly includes an outer gimbal 302 that is pivotally supportedby a housing of the proximal control mechanism and an inner gimbal 304that is pivotally supported by the outer gimbal. The axes of the innerand outer gimbal assemblies intersect and allow the inner gimbalassembly to move with two degrees of rotational freedom, one for each ofthe two axes of the gimbal assembly. The inner gimbal has a center ofrotation at the intersection of the inner and outer axes. U.S. patentapplication Ser. No. 12/060,104, which is incorporated herein in itsentirety, discloses couplers for providing the controlling input.

The articulated sections 252, 254 (FIG. 2) of the surgical instrumentsare also gimbals, each having two degrees of rotational freedom. Thus itis possible to control the movement of the articulated sections 252, 254by copying the motion of the input at the inner gimbal 304 to the outputat the output gimbal of the articulated sections. It will be appreciatedthat the input gimbal is substantially larger than the output gimbal inthe embodiment shown. Therefore it is desirable to use a forcetransmission apparatus that scales the motions of the input gimbal toprovide motions that are appropriate for controlling the output gimbal.The mechanisms that provide the controlling motions to the input gimbalare generally bulky while it is necessary for the output gimbals to becompact and located in close proximity to one another. Therefore it isdesirable to use a force transmission apparatus that spatiallytranslates the motions of the input gimbals to allow the output gimbalsto be closely packed.

FIG. 4 shows a perspective view of the coupler portion 132 of theteleoperated manipulator 130. The coupler 132 includes a plate 400 thatbears against the inner gimbal 304 of the gimbal assembly 300 in theproximal control mechanism 240 of the surgical instrument 120 when theinstrument is connected to the teleoperated manipulator 130. The forcesapplied to the inner gimbal 304 by the plate 400 control movements ofthe surgical instrument 120.

FIG. 5 shows a simplified perspective view of a force transmissionmechanism that transfers the forces applied on the inner gimbal 304 toone of the articulated sections 254 at a distal end of the elongate tube210. The inner gimbal 304 acts as an input gimbal plate having twodegrees of freedom. The input gimbal plate is coupled to three leverarms 512, 514, 516 by three coupler links 502, 504, 506.

In the embodiment shown, each coupler link includes an inner link 506Athat slides within an outer link 506B. This allows the link 506 totransmit an downward movement of the inner gimbal 304 by pressing on thelink. When the inner gimbal 304 moves up, the outer link 506B slidesover the inner link 506A preventing the link 506 from transmitting anupward movement of the inner gimbal. Part of the link, preferably theouter link 506B, may be made of a non-conductive material, such asplastic, to electrically isolate the inner gimbal 304 from the surgicalinstrument 120.

Each lever arm is supported by a pivot 508 between a first end 507 and asecond end 509 of the lever arm. A first end 503 of each of the couplerlinks is pivotally coupled to the first end of one of the lever arms512, 514, 516. A second end 501 of each of the coupler links ispivotally coupled to the input gimbal plate 304, such as by a ball andsocket connection. The second ends of the coupler links are notcollinear so that any change in the position of the input gimbal plate304 will move at least one of the coupler links.

The articulated section 254 at the distal end of the elongate tube 210provides two degrees of angular freedom. Three output links 522, 524,526, such as flexible cables, are coupled to a plate at the distal endof the articulated section 254 at a first end 527 of the output link andcoupled to the second end of one of the lever arms 516 at a second end525 of the output link. In the embodiment shown in FIG. 2, thearticulated section 254 moves the tubular section 258 to position thesurgical tool 256 within the surgical site.

A first end 532 of the elongate tube 210 is adjacent the lever arms 512,514, 516, which are part of the proximal control mechanism 240. Theoutput links 522, 524, 526 are substantially contained within the tube210 with the links extending from the opposing ends of the tube toconnect to the lever arms and the articulated sections. Any forceapplied to move the input gimbal plate 304 will be transmitted to movethe output gimbal plate 536 to a corresponding position because thethree non-collinear connections to each gimbal plate define a uniqueorientation of each gimbal plate. It will be appreciated that while theoutput plate 536 is described as a gimbal plate because it has twodegrees of angular freedom, the embodiment shown is not a true gimbalbecause the axes of rotation for the plate do not intersect and do notlie in the same plane as the plate. The small scale of the joint makesit difficult to construct the joint as a true gimbal. Nonetheless, theoutput plate 536 does track the movements of the input gimbal plate 304and it is therefore helpful to consider the output plate as the outputgimbal plate.

The connections to the gimbal plates are arranged so that for each axisof rotation, there are connections on both sides of the axis that arespaced substantially away from the axis. Thus any movement of the inputgimbal plate 304 will create tension in at least one of the three outputlinks 521, 523, 525. That tension will cause the output gimbal plate 536to move and apply tension to any of the three output links 522, 524,526, that are not in tension from movement of the input gimbal plate304. Flexible cables can be used for the output links because theoperation of the force transmission maintains tension in all the outputlinks under most operating conditions. However, under some loadconditions one or more output links can go slack. Using coupler linksthat include an inner link 506A that slides within an outer link 506Bprevents movement of the input gimbal plate 304 from unloading theoutput links.

FIG. 6 is a bottom view of a portion of the force transmission mechanismshown in FIG. 5. In this embodiment, it will be seen that a firstdistance between adjacent first ends 503 of the coupler links 502 isgreater than a second distance between adjacent second ends 521 of theoutput links 522. This allows a larger actuator to be used to applyforce to a larger input gimbal plate 304 relative to the size of theoutput gimbal plate 536 and the elongate tube 210 which are 5 to 6 mm indiameter in the embodiment shown.

FIG. 7 is a top view of a portion of the force transmission mechanismshown in FIG. 5. FIGS. 6 and 7 show how the cables are routed from theends 509 of the lever arms 512, 514, 516 into the top 532 of theelongate tube 210. In the embodiment shown, the cables are substantiallyequally spaced around the outer perimeter of the tube 210 which allows amaximum force to be applied to the output gimbal plate.

FIG. 8 is a side view of a portion of the force transmission mechanismshown in FIG. 5. Only one coupler link 502, lever arm 512, and outputlink 522 are shown to allow the arrangement of the coupling of theseparts to be clearly seen. It will be appreciated that the location ofthe pivot 508 that supports the lever arm 512 can be chosen to providevarious ratios of movement and force between the first end 503 of thecoupler link 502 and the second end 521 of the output link 522.

FIG. 9 shows a simplified perspective view of another force transmissionmechanism that transfers the forces applied on an inner gimbal 904 to anarticulated section 252 at a distal end of the elongate tube 210. Inthis embodiment, the articulated section 252 is a “wrist” that supportsthe surgical tool 256. The wrist 252 is coupled to the distal end of thetubular section 258, which allows the wrist to be positioned adjacentthe surgical site.

The articulated section 252 acts as an output gimbal plate having twodegrees of angular freedom coupled to a secondary output gimbal platehaving two degrees of angular freedom. The articulated section 252 inthe embodiment shown includes five segments. Each pair of segments iscoupled such that the segments of the pair can rotate (e.g., pitch oryaw) relative to one other around a single axis. Three adjacent segmentsact as a gimbal plate because the two axes of the two pairs of segmentsare orthogonal to one another. The three segments 920, 925, 930 farthestfrom the distal end of the elongate tube 210 act as the output gimbalplate. The first segment 920 of the output gimbal plate along with thetwo segments 925, 930 closest to the distal end act as the secondaryoutput gimbal plate.

The use of two stacked gimbals permits a greater range of angularmovement and provides a greater radius of curvature for the articulationof the wrist. The secondary output gimbal plate moves to a first anglethat is a portion of the total angle of the wrist movement and theoutput gimbal plate moves the remainder of the total angle. In theembodiment shown, the secondary output gimbal plate moves throughone-half of the total angle and the output gimbal plate moves throughthe same amount relative to the secondary output gimbal plate to providethe total angle of movement.

The input gimbal plate 904 is coupled to three lever arms 932, 934, 936by three coupler links 962, 964, 966. Each lever arm is supported by apivot 954 between a first end 957 and a second end 959 of the lever arm.A first end 950 of each of the coupler links is pivotally coupled to thefirst end 957 of one of the lever arms 932, 934, 936. A second end ofeach of the coupler links is pivotally coupled to the input gimbal plate904, such as by a ball and socket connection. The second ends of thecoupler links are not collinear so that any change in the position ofthe input gimbal plate 904 will move at least two of the coupler linksin opposite directions.

Three output links 912, 914, 916, such as flexible cables, are coupledto the output gimbal plate 930 at a first end of the output links andcoupled to the second end 959 of the lever arms 932, 934, 936 at asecond end of the output links. The output gimbal plate 930 moves inresponse to movements of the input gimbal plate 904 in substantially thesame way as described above for the embodiment shown in FIGS. 5-8.

Three secondary levers 942, 944, 946 are provided to control threesecondary output links 922, 924, 926. Each of the secondary output linkshas a first end coupled to the secondary output gimbal plate 920 and asecond end coupled to one of the secondary levers. The secondary outputlinks 922, 924, 926 are arranged to move the secondary output links 922,924, 926 with a motion that is proportional to the motion of theassociated output links 912, 914, 916. In the embodiment shown, eachsecondary output link moves one-half the distance of the associatedoutput link in the opposite direction. The secondary output link iscoupled to the secondary output gimbal plate 920 at a point that isdiametrically opposite the point where the output link for theassociated output link is coupled to the output gimbal plate 930. Thiscauses the secondary output gimbal plate 920 to move through half theangle of the output gimbal plate 930. Both gimbals move in the samedirection because the diametrically opposed attachments cancel theeffect of the opposite directions of motion at the levers.

Each secondary lever 942, 944, 946 is supported by a secondary pivot952. The pivots 954 that support the lever arms 932, 934, 936 and thesecondary pivots 952 that support the secondary levers 942, 944, 946 aresupported by a ground frame 970 that is in a fixed relationship to theelongate tube 210. The ground frame 956 provides the frame of referencefor the movements of the force transmission mechanism.

FIGS. 10A and 10B show one of the lever arms 932 and one of thesecondary levers 942 associated with the lever arm with a schematicrepresentation of the articulated section 252. The ground frame 956 hasbeen omitted for clarity to show how the mechanism works. It is helpfulto remember when viewing FIGS. 10A and 10B that lever arm 932 pivotsaround pivot 954, secondary lever 942 pivots around pivot 952, and bothpivots 952 and 954 are fixed with reference to one another in the groundframe 956. FIG. 10A shows the lever arm 932 and the secondary lever 942in a first position where the articulated section 252 is straight. FIG.10B shows the lever arm 932 in a second position where a force on thefirst end 950 of the coupler link (not shown) has raised the first end957 of the lever arm 932. This causes the second end 959 of the leverarm 932 to be lowered, extending the output link 912 that is coupled tothe second end of the lever arm 932.

It will be appreciated that the output link 912 may be flexible andunable to transmit a significant force in compression. However, at leastone of the remaining two output links 914, 916 will be retracted becausethe connections to the gimbal plates are arranged so that for eachgimbal axis of rotation, there are connections on both sides of thegimbal axis that are spaced substantially away from the gimbal axis.Thus, when an output link is extended, the output gimbal plate will bemoved by another output link that is retracted and applies tension tothe extended output link.

Each secondary lever 942 is supported by the secondary pivot 952 at afirst end of the secondary lever. A secondary output link 922 is coupledto a second end of the secondary lever 942. A force applying connector1000 is fixed to the lever arm 932 and is coupled to the secondary lever942 associated with the lever arm 932 to apply a force to the secondarylever when the lever arm 932 is moved.

In the embodiment shown, the force applying connector 1000 applies forceto the secondary lever 942 at a point that is between the pivot 952 andthe load of the secondary output link 922, making the secondary lever athird class lever. The force applying connector 1000 is fixed to thelever arm 932 between the pivot 954 that supports the lever arm and thesecond end 950 of the coupler link 966 that is coupled to the lever arm.The portion of the lever arm 932 that applies the force to the secondarylever 942 therefore acts as a second class lever.

Since the overall lever arm 932 is a first class lever, where theapplied force moves the load in the opposite direction, the forceapplying connector 1000 moves in the same direction as the applied forceand in the opposite direction as the output link 912. Since thesecondary lever 942 is a third class lever, the force applied by theforce applying connector 1000 moves the load of the secondary outputlink 922 in the same direction as the motion of the force applyingconnector and in the opposite direction as the output link 912. In theembodiment shown, the secondary levers are configured so that the outputdisplacement of the secondary levers is half the output displacement ofthe lever arms to meet the requirements of the articulated wrist section252. In other embodiments, the output displacement of the secondarylever may be configured to have other relationships to the outputdisplacement of the lever arm.

FIGS. 11 and 12 show a front and oblique views of a portion of anotherforce transmission mechanism. As in the embodiment shown in FIGS. 9 and10, this embodiment includes secondary levers 1142, 1144, 1146 that aremoved in an opposite direction by movement of primary lever arms 1132,1134, 1136. The output links that are connected to the ends of theselever arms are not shown to allow others aspects to be seen moreclearly.

As the primary lever arms 1132, 1134, 1136 are moved, they cause thesecondary levers 1142, 1144, 1146 to move in an opposite direction. Thiscan apply forces to the primary levers that limits their range ofmotion. An equalizer cable 1100 can link the primary lever arms 1132,1134, 1136 at the driven ends to overcome the additional forces on theprimary levers from the interaction with the secondary levers 1142,1144, 1146. The equalizer cable 1100 is coupled to the two outsideprimary levers 1132, 1136 and routed over a lever arm pulley 1102supported by the primary lever arm 1134 that is between the outsideprimary lever arms. Two idler pulleys 1104, 1106 route the cable fromthe lever arm pulley 1102 to the outside primary levers 1132, 1136. Theequalizer cable 1100 can be arranged to provide a kinematic constrainton the motion of the driven ends of the primary lever arms 1132, 1134,1136 because these motions are coupled by the gimbal plate (not shown)that drives the three primary lever arms.

FIG. 13 is a plan view of a gimbal plate 1304 that drives the primarylevers 1132, 1134, 1136 (FIGS. 11 and 12). The input gimbal plate 1304is coupled to the primary levers 1132, 1134, 1136 by three coupler links(not shown). The coupler links are attached to the gimbal plate at threepoints 1302, 1306, 1308 that are not collinear so that any change in theposition of the input gimbal plate 1304 will move at least two of thecoupler links and the primary levers they drive in opposite directions.For example, if the gimbal plate is rotated about the axis that runsthrough the point 1302 where one of the coupler links is attached to thegimbal plate, the remaining two coupler links move in oppositedirections. As another example, if the gimbal plate is rotated about theaxis line indicated by reference numeral 1310, the two coupler linksattached to points 1302, 1306 on one side of the axis will move in onedirection and the coupler link attached to the points 1308 on the otherside of the axis will move in the opposite direction.

In the embodiment shown, the three points 1302, 1306, 1308 of attachmentfor the coupler links are equidistant from the center of motion of theinput gimbal plate 1304. The distance from the center of motion to thepoints of attachment is represented by the distance R. The three points1302, 1306, 1308 of attachment are spaced apart equally so that theangle α between the lines connecting center of motion and two points ofattachment is 120°. If the input gimbal plate 1304 is rotated about anarbitrary axis 1310 through an angle β, each point of attachment will bedisplaced by a distancea=βR sin φwhere φ is the angle between the axis 1310 and the line connecting thecenter of motion and the point of attachment. If the angle between theaxis 1310 and the line connecting the center of motion and a first pointof attachment 1302 is θ, then the angles for the other two points ofattachment 1306, 1308 are (θ+α) and (θ−α). Therefore the displacementsfor the three points 1302, 1306, 1308 of attachment area1=βR sin θa2=βR sin(θ+α)a3=βR sin(θ−α)

Using the trigonometric identity ofsin(a+b)=sin a cos b+cos a sin bthe sum of the displacements for the three points 1302, 1306, 1308 ofattachment isa1+a2+a3=βR(sin θ+sin θ cos α+cos θ sin α+sin θ cos−α+cos θ sin−α)This can be rewritten asa1+a2+a3=βR[sin θ(1+cos α+cos−α)+cos θ(sin α+sin−α)]

Since α is 120°,cos α=cos−α=−0.5sin α=0.886sin−α=−0.886The sum of the displacements for the three points 1302, 1306, 1308 ofattachment therefore simplifies to

a 1 + a 2 + a 3 = β R[sin   θ  (1 − 0.5 − 0.5) + cos   θ (0.886 − 0.886)] = 0

FIG. 14 is a schematic representation of the primary levers 1132, 1134,1136, the pulleys 1102, 1104, 1106, and the equalizer cable 1100. Eachprimary lever arm is supported by a pivot 1154. In the embodiment shown,the primary levers 1132, 1134, 1136 are supported by a common pivotshaft 1154 that is supported by a common ground frame 1156. In otherembodiments, each primary lever is supported by its own pivot that issupported by a common ground frame. The two idler pulleys 1104, 1106 arepivotally supported by the common ground frame 1156. The lengths of theequalizer cable 1100 segments between each of the primary levers 1132,1134, 1136 and the grounded idler pulleys 1104, 1106 changes as thelevers move. The displacements of the lever outputs are indicated as d1,d2, and d3 in FIG. 14. The net change of length in the equalizer cable1100 due to the displacements of the lever outputs isd1+2d2+d3where the displacement d2 is doubled because of the effect of the pulley1102.

For the embodiment shown, the two ends of the equalizer cable 1100 arefixed to the two outer primary levers 1132, 1136 at a distance L fromthe pivot 1154. The pulley 1102 on the middle primary levers 1134 ispivotally supported at a distance L/2 from the pivot 1154. The outputdisplacement d of a first class lever is related is related to the inputdisplacement a byd/L=−a/Xwhere L is the distance between the fulcrum or pivot of the lever andthe point of the output displacement and X is the distance between thefulcrum and the point of the input displacement. Since L and X are thesame for all primary levers in the embodiment shownd1=−a1L/Xd2=−a2L/2Xd3=−a3L/X

The net change of length in the equalizer cable 1100 is therefore−a1L/X+2(−a2L/2X)+(−a3L/X)This can be rewritten as−L/X(a1+a2+a3)Since it was previously shown thata1+a2+a3=0for the embodiment shown, the movement of the primary levers 1132, 1134,1136 does not change the length of the equalizer cable 1100. Therefore,the equalizer cable 1100 provides a kinematic constraint to maintain theproper relationship between the output ends of the primary levers 1132,1134, 1136 by transferring upward forces in the outputs of the primarylevers to downward forces on the remaining primary levers.

While certain exemplary embodiments have been described and shown in theaccompanying drawings, it is to be understood that such embodiments aremerely illustrative of and not restrictive on the broad invention, andthat this invention is not limited to the specific constructions andarrangements shown and described, since various other modifications mayoccur to those of ordinary skill in the art. The description is thus tobe regarded as illustrative instead of limiting.

What is claimed is:
 1. A force transmission comprising: a primary outputgimbal plate having two degrees of freedom; three primary levers, eachprimary lever supported by a primary pivot, each primary lever iscoupled to the primary output gimbal plate by one of three couplingsthat are not collinear; a secondary output gimbal plate coupled to theprimary output gimbal plate, the secondary output gimbal plate havingtwo degrees of freedom; and three secondary levers, each secondary leversupported by a secondary pivot, each secondary lever coupled to one ofthe primary levers by a force applying connector, each secondary leveris coupled to the secondary output gimbal plate by one of threecouplings that are not collinear.
 2. The force transmission of claim 1wherein the secondary levers are third class levers.
 3. The forcetransmission of claim 1 wherein the force applying connector is fixed tothe primary lever between the primary pivot that supports the primarylever and an end of the primary lever that is coupled to the primaryoutput gimbal plate.
 4. The force transmission of claim 1 wherein thethree primary levers are coupled to the primary output gimbal plate bythree flexible primary cables and the three secondary levers are coupledto the secondary output gimbal plate by three flexible secondary cables.5. The force transmission of claim 4 further comprising a tube having afirst end adjacent the primary levers and an opposing second endadjacent the secondary output gimbal plate, wherein the primary andsecondary cables are substantially contained within the tube.
 6. Theforce transmission of claim 1 further comprising a surgical end effectorcoupled to the primary output gimbal plate.
 7. The force transmission ofclaim 1 wherein a first distance between adjacent ends of the primarylevers coupled to the primary output gimbal plate is less than a seconddistance between adjacent opposing ends of the primary levers.
 8. Aforce transmission for a teleoperated surgical instrument comprising: aninput gimbal plate having two degrees of freedom; a primary outputgimbal plate having two degrees of freedom; three primary levers, eachprimary lever supported by a primary pivot, each primary lever coupledto the input gimbal plate by one of three couplings that are notcollinear, each primary lever coupled to the primary output gimbal plateby one of three couplings that are not collinear; a secondary outputgimbal plate having two degrees of freedom; and three secondary levers,each secondary lever supported by a secondary pivot, each secondarylever coupled to one of the primary levers by a force applyingconnector, each secondary lever coupled to the secondary output gimbalplate by one of three couplings that are not collinear.
 9. The forcetransmission of claim 8 wherein the secondary levers are third classlevers.
 10. The force transmission of claim 8 wherein the force applyingconnector is fixed to the primary lever between the primary pivot thatsupports the primary lever and an end of the primary lever that iscoupled to the primary output gimbal plate.
 11. The force transmissionof claim 8 wherein the three primary levers are coupled to the primaryoutput gimbal plate by three flexible primary cables and the threesecondary levers are coupled to the secondary output gimbal plate bythree flexible secondary cables.
 12. The force transmission of claim 11further comprising a tube having a first end adjacent the primary leversand an opposing second end adjacent the secondary output gimbal plate,wherein the primary and secondary cables are substantially containedwithin the tube.
 13. The force transmission of claim 8 furthercomprising a surgical end effector coupled to the primary output gimbalplate.
 14. The force transmission of claim 8 wherein a first distancebetween adjacent ends of the primary levers coupled to the primaryoutput gimbal plate is less than a second distance between adjacentopposing ends of the primary levers.
 15. A force transmissioncomprising: an input gimbal means for receiving an input force havingtwo degrees of freedom; a primary output gimbal means for delivering theinput force with two degrees of freedom; three primary levers, eachprimary lever supported by a pivot; coupler means for coupling the inputgimbal means to the primary levers; and primary link means for couplingthe primary levers to the primary output gimbal means; a secondaryoutput gimbal means for moving the primary output gimbal means with twodegrees of freedom; three secondary levers, each secondary leversupported by a secondary pivot; secondary link means for coupling thesecondary levers to the secondary output gimbal means; and forceapplying means for transferring a secondary force from the primarylevers to the secondary levers.
 16. The force transmission of claim 15further comprising a tube means for substantially containing the primaryand the secondary link means.
 17. The force transmission of claim 15wherein the primary output gimbal means supports a surgical endeffector.
 18. A method of transmitting force to a teleoperated surgicalinstrument, the method comprising: receiving a force input with an inputgimbal plate having two degrees of freedom; transferring the force inputto the three primary levers, each primary lever supported by a pivot;transferring a primary force output from the three primary levers to anarticulated joint that supports a surgical end effector; transferring asecondary force to three secondary levers, each secondary leversupported by a secondary pivot, the secondary force being transferredfrom the primary levers to the secondary levers by force applyingconnectors; and transferring a secondary force output from the secondarylevers to the articulated joint.